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重度精神疾病的成本效益分析:结局指标的选择

Cost-effectiveness analysis in severe mental illness: outcome measures selection.

作者信息

Stant A Dennis, Buskens Erik, Jenner Jack A, Wiersma Durk, TenVergert Elisabeth M

机构信息

Office for Medical Technology Assessment, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands.

出版信息

J Ment Health Policy Econ. 2007 Jun;10(2):101-8.

Abstract

BACKGROUND

Most economic evaluations conducted in mental healthcare did not include widely recommended preference-based health outcomes like the QALY (Quality-Adjusted Life Years). Instead, studies have mainly been designed as cost-effectiveness analyses that include single outcome measures aimed at a (disease) specific aspect of health.

AIMS OF THE STUDY

To raise awareness about the potential problems related to the selection of outcome measures for economic studies in patient populations with severe mental illness. Furthermore, to make suggestions that may prevent these problems in future economic evaluations.

METHODS

Data of a previously conducted economic evaluation assessing the cost-effectiveness of the HIT (Hallucination focused Integrative Treatment) intervention in patients with schizophrenia were used for the analyses presented in the current paper. Economic analyses based on the results of the selected primary health outcome (Positive and Negative Syndrome Scale: PANSS) were compared with results based on various other health outcomes assessed during the study, including QALYs.

RESULTS

No relevant differences between groups were found on the single primary health outcome initially included in the cost-effectiveness analysis. In contrast, relevant and significant differences were identified on three of the four additionally assessed health outcomes. Conclusions based on the results of multiple cost-effectiveness analyses and acceptability curves were strongly in favour of the experimental intervention when including these three additional instruments. QALY results did not show differences between groups.

DISCUSSION

Selecting between outcome measures for cost-effectiveness analysis in the field of mental healthcare appears to be a complicated process, which may have considerable consequences for the results of economic studies and subsequent policy decisions. It was argued that inconsistent results across the selected primary health outcome and additionally assessed health outcomes should explicitly be presented to decision-makers. Until there is consensus on a preference-based instrument suited for severe mental illness, QoL instruments could be applied instead of instruments aimed at specific aspects of health.

IMPLICATIONS FOR HEALTH POLICIES

Decision-makers in the field of mental healthcare should be careful when interpreting results of economic studies that included outcome measures aimed at a specific aspect of health. Such instruments may provide too narrow a view on relevant changes in health and findings may be difficult to generalise. Due to current reservations on the use of QALYs in mental healthcare, QALY outcomes should be considered in the context of the results of additionally assessed health outcomes.

摘要

背景

大多数在精神卫生保健领域进行的经济评估并未纳入像质量调整生命年(QALY)这样被广泛推荐的基于偏好的健康结果。相反,研究主要被设计为成本效益分析,其中包括针对健康的特定(疾病)方面的单一结果指标。

研究目的

提高对严重精神疾病患者群体经济研究中结果指标选择相关潜在问题的认识。此外,提出在未来经济评估中可能预防这些问题的建议。

方法

先前一项评估幻觉聚焦综合治疗(HIT)干预对精神分裂症患者成本效益的经济评估数据被用于本文所呈现的分析。将基于所选主要健康结果(阳性和阴性症状量表:PANSS)结果的经济分析与基于研究期间评估的各种其他健康结果(包括QALY)的结果进行比较。

结果

在成本效益分析最初纳入的单一主要健康结果上,各群体之间未发现相关差异。相比之下,在另外评估的四项健康结果中的三项上发现了相关且显著的差异。当纳入这三项额外指标时,基于多项成本效益分析结果和可接受性曲线得出的结论强烈支持实验性干预。QALY结果未显示各群体之间存在差异。

讨论

在精神卫生保健领域选择成本效益分析的结果指标似乎是一个复杂的过程,这可能对经济研究结果及后续政策决策产生重大影响。有人认为,应将所选主要健康结果与额外评估的健康结果之间的不一致结果明确呈现给决策者。在就适用于严重精神疾病的基于偏好的指标达成共识之前,可应用生活质量指标而非针对健康特定方面的指标。

对卫生政策的启示

精神卫生保健领域的决策者在解释包含针对健康特定方面结果指标的经济研究结果时应谨慎。此类指标可能对健康的相关变化提供过于狭隘的观点,且研究结果可能难以推广。由于目前对在精神卫生保健中使用QALY存在保留意见,应在额外评估的健康结果结果背景下考虑QALY结果。

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